Reconstruction Of Bony Defects Research Articles

Does Fibula Free Flap Harvesting Affect Donor Site of Patients in Facial Reconstructions: A Gait Analysis Study

BackroundVascularized fibula free flap remains gold standard for reconstruction of bony defects of the maxilla or mandible. Research and publications in recent years essentially focused on the evolution and improvement of the recipient reconstructed area but very few concerning the donor site morbidity. PurposeThe aim of this study was to analyze walking ability of patients following vascularized fibula free flap (VFFF) operation and to determine if there are long term walking disabilities. Study designThe retrospective cohort study involved healthy controls and patients who had undergone VFFF between 2012 and 2019 at the oral and maxillo-facial department of the University Hospital in Lausanne, Switzerland. Patients with cardiovascular, pulmonary, neuromuscular or musculoskeletal pathologies that could impair walking were excluded from the study. Predictor/exposure/independent variablesPrimary predictor is the reconstruction status, vascularized fibula free flap (VFFF) vs healthy patients (controls) Main outcome variablesMain outcomes were gait parameters. Objective evaluation of walking abilities was assessed using the Gait up ® system (Gait Up SA, EPFL Innov’Park-C, Lausanne Switzerland), which are wearable motion sensors that provides 3D analytics of the gait. CovariatesCovariates implied patient characteristics such as age, sex, time after surgery and subjective evaluation of the gait obtained with two orthopedic validated questionnaires. ResultsThis study implied 10 healthy controls and 11 patients who had undergone VFFF. Results showed statistically significant differences in the speed [m/s] (1.3 vs 1.1 for a p-value of 0.001) , the stride length [m] (1.4 vs 1.2 for a p-value of 0.003), the flat foot phase [%] (55.0 vs 63.3 for a p-value of 0.006) and the pushing phase [%] (34.1 vs 25.1 for a p-value of 0.008). Conclusion and RelevanceReconstruction using vascularized autograft in maxillofacial surgery is substantial and well described. Our attention focusing on donor site morbidity has demonstrated subjective and objective long-term alterations. These results will have to be confirmed with gait analysis in a prospective project including pre-operative and post-operative analysis of the gait of the patient acting himself as his own control, with a larger scale of patients.

Antibacterial properties of marine algae incorporated polylactide acid membranes as an alternative to clinically applied different collagen membranes

The reconstruction of bony defects in the alveolar crest poses challenges in dental practice. Guided tissue regeneration (GTR) and guided bone regeneration (GBR) procedures utilize barriers to promote bone regeneration and prevent epithelial growth. This study focuses on evaluating the antibacterial properties of marine algae-polylactic acid (PLA) composite membranes compared to commercially available collagen membranes. Marine algae (Corallina elongata, Galaxaura oblongata, Cystoseira compressa, Saragassum vulgare, and Stypopodium schimperi) were processed into powders and blended with PLA to fabricate composite membranes. Cytocompatibility assays using human periodontal ligament fibroblasts (n = 3) were performed to evaluate biocompatibility. Antibacterial effects were assessed through colony-forming units (CFU) and scanning electron microscopy (SEM) analysis of bacterial colonization on the membranes. The cytocompatibility assays demonstrated suitable biocompatibility of all marine algae-PLA composite membranes with human periodontal ligament fibroblasts. Antibacterial assessment revealed that Sargassum vulgare-PLA membranes exhibited the highest resistance to bacterial colonization, followed by Galaxaura oblongata-PLA and Cystoseira compressa-PLA membranes. SEM analysis confirmed these findings and revealed smooth surface textures for the marine algae-PLA membranes compared to the fibrous and porous structures of collagen membranes. Marine algae-PLA composite membranes show promising antibacterial properties and cytocompatibility for guided bone and tissue regeneration applications. Sargassum vulgare-PLA membranes demonstrated the highest resistance against bacterial colonization. These findings suggest that marine algae-PLA composite membranes could serve as effective biomaterials for infection control and tissue regeneration. Further in vivo validation and investigation of biodegradation properties are necessary to explore their clinical potential.Graphical

Versatility of Free Vascularised Fibular Flap in Extremity Reconstruction: A Retrospective Study

Introduction: Complex wounds of the extremities have always been a challenge for the reconstructive surgeon. Non-vascularized methods for the reconstruction of bony defects are associated with more complications. So the free vascularised fibular flap (FVFF) has become a workhorse flap for the reconstruction of these defects. In this study we aim to share our experience of reconstruction of such defects using free vascularised fibular flap. Material and methods: We performed a retrospective study of the 18 patients who underwent extremity reconstruction with free vascularised fibular flap at our hospital i.e. Yenepoya Medical College and Hospital, Mangaluru during a five-year period i.e. from January 2019 to December 2023. In all these patients, we studied and evaluated the cause and location of defects, type of free vascularised fibular flap, choice of the recipient vessels, type of the anastomosis, the survival rate, functional outcomes and complications. Results: Totally 18 patients with a mean age of 39.4 years had undergone extremity reconstruction with a free vascularised fibular flap with complete bone viability. The defects were present within the humerus, radius, femur, tibia and metatarsal. Union at the osteotomy sites was noted radiologically at an average time of five months. The average period to return function was 14 months. Conclusions: The use of a free vascularised fibula flap is the best modality for the reconstruction of the bony defects of the limb and is proved to have a high bony healing rate, early return to ambulation, good function of the extremity and less incidence of complication regardless of the cause of the bony defect. One or more skin paddle can be taken along with the bone for the coverage in case of exposure of deeper tissue.

Evaluation of the biocompatibility, antibacterial and anticancer effects of a novel nano-structured Fe–Mn-based biodegradable alloys in-vitro study

Scientific backgroundsDevelopment of nanostructured biodegradable alloys has generated a great deal of interest in the recent years as they offer promising bioactive materials for reconstruction of bony defects following traumatic fractures or surgical excision of tumors. ObjectivesThe aim of the current study was to investigate the biocompatibility of Iron–Manganese -based alloys (Fe–Mn) with addition of copper (Cu), Tungsten (W) and cobalt (Co) to obtain 3 different alloys namely, Fe–Mn–Cu, Fe–Mn–W, and Fe–Mn–Co on normal oral epithelial cell line,and their possible anticancer effect on MG-63: osteosarcoma cell line. Materials and methodsThe sulforhodamine B (SRB) assay was used to assess cell viability percentage of both cell lines after exposure to discs of the proposed experimental alloys. Moreover, the antibacterial effect of such alloys against Escherichia coli (E. coli) was tested using disc diffusion susceptibility (Kirby-Bauer method) and colony suspension method. ResultsThe cell viability percentage of oral epithelial cell line showed a significant increase in all the experimental groups in comparison to the control group. The highest percentage was observed in Fe–Mn–Co group, followed by Fe–Mn–W then Fe–Mn–Cu, at 24 and 72-h intervals, respectively. While the cell viability percentage of osteosarcoma cell line showed significant increase in all the experimental groups at 24-h intervals, it showed a significant drop in all the study groups at 72-h intervals. The lowest percentage was observed in Fe–Mn–Cu group, followed by Fe–Mn–W then Fe–Mn–Co. Moreover, all the examined study groups didn't show any inhibition zones against E. coli reference culture. ConclusionsThe novel nanostructured biodegradable Fe–Mn–Cu, Fe–Mn–W, and Fe–Mn–Co metal alloys exhibit good biocompatibility on oral epithelial cell lines with the enhancement of cell proliferation in a time-dependent manner that favors bone regeneration. On the other hand, all the alloys manifested possible anticancer activity against MG-63: osteosarcoma cell line. Furthermore, our study sheds the light on the importance of Co, W and Cu as promising alloying elements. However, the antibacterial activity of the examined alloys is still questionable. Clinical relevanceThe novel nanostructured biodegradable Fe–Mn–Cu, Fe–Mn–W, and Fe–Mn–Co metal alloys offer promising bioactive materials for reconstruction of bony defects following traumatic fractures or surgical excision of tumors, In addition, they could be excellent alternatives for undegradable or non-resorbable alloys that are commonly used. Moreover, they could be used as beneficial 3D printing materials to obtain patient-specific medical implants that favor bone regeneration in addition to manufacturing of plates and screws suitable for fracture fixation.

Composite grafts made of polycaprolactone fiber mats and oil-based calcium phosphate cement pastes for the reconstruction of cranial and maxillofacial defects

ObjectivesSynthetic bone substitutes which can be adapted preoperatively and patient specific may be helpful in various bony defects in the field of oral- and maxillofacial surgery. For this purpose, composite grafts made of self-setting and oil-based calcium phosphate cement (CPC) pastes, which were reinforced with 3D-printed polycaprolactone (PCL) fiber mats were manufactured.Materials and methodsBone defect models were acquired using patient data from real defect situations of patients from our clinic. Using a mirror imaging technique, templates of the defect situation were fabricated via a commercially available 3D-printing system. The composite grafts were assembled layer by layer, aligned on top of these templates and fitted into the defect situation. Besides, PCL-reinforced CPC samples were evaluated regarding their structural and mechanical properties via X-ray diffraction (XRD), infrared (IR) spectroscopy, scanning electron microscopy (SEM), and 3-point-bending testing.ResultsThe process sequence including data acquisition, template fabrication, and manufacturing of patient specific implants proved to be accurate and uncomplicated. The individual implants consisting mainly of hydroxyapatite and tetracalcium phosphate displayed good processability and a high precision of fit. The mechanical properties of the CPC cements in terms of maximum force and stress load to material fatigue were not negatively affected by the PCL fiber reinforcement, whereas clinical handling properties increased remarkably.ConclusionPCL fiber reinforcement of CPC cements enables the production of very freely modelable three-dimensional implants with adequate chemical and mechanical properties for bone replacement applications.Clinical relevanceThe complex bone morphology in the region of the facial skull often poses a great challenge for a sufficient reconstruction of bony defects. A full-fledged bone replacement here often requires the replication of filigree three-dimensional structures partly without support from the surrounding tissue. With regard to this problem, the combination of smooth 3D-printed fiber mats and oil-based CPC pastes represents a promising method for fabricating patient specific degradable implants for the treatment of various craniofacial bone defects.

Spheno-Orbital Meningioma and Vision Impairment—Case Report and Review of the Literature

(1) Background: Spheno-orbital meningioma (SOM) is a very rare subtype of meningioma which arises from the sphenoid ridge with an orbital extension. It exhibits intraosseous tumor growth with hyperostosis and a widespread soft-tissue growth at the dura. The intra-orbital invasion results in painless proptosis and slowly progressing visual impairment. (2) Methods: We present a case of a 46-year-old woman with SOM and compressive optic nerve neuropathy related to it. Her corrected distance visual acuity (CDVA) was decreased to 20/100, she had extensive visual field (VF) scotoma, dyschromatopsia, impaired pattern-reversal visual-evoked potential (PVEP), and decreased thicknesses of the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC), measured with the swept-source optical coherence tomography (SS-OCT), and a pale optic nerve disc in her left eye. Brain CT and MRI showed a lesion at the base of the anterior cranial fossa, involving the sphenoid wing and orbit. Pterional craniotomy and a partial removal of the tumor at the base of the skull and in the left orbit with the resection of the lesional dura mater and bony defect reconstruction were performed. (3) Results: The histological examination revealed meningothelial meningioma (WHO G1). Decreased CDVA and VF defects completely recovered, and the color vision score and PVEP improved following the surgery, but RNFL and GCC remained impaired. No tumor recurrence was observed at a follow-up of 78 months. (4) Conclusions: Optic nerve dysfunction has the capacity to improve once the compression has been relieved despite the presence of the structural features of optic nerve atrophy.

Utilization of the Free Fibular Flap for First Metatarsal Reconstruction.

Beyond being aesthetically unpleasing, metatarsal defects have been known to lead to several patient concerns such as intermetatarsal malpositioning and metatarsalgia. There are several reconstructive techniques that have been utilized for reconstruction of bony defects in the foot, including the free dorsal toe flap and dorsal metatarsal perforator flap. Our institution has utilized the free fibular flap for surgical management pertaining to tarsal reconstruction. Our study looks to evaluate the work of a single plastic surgeon and identify patient postoperative outcomes. A retrospective chart review was conducted at Beaumont Health System, Royal Oak for patients who underwent first metatarsal reconstruction with a free fibular flap between the years 2015 and 2022. Demographic data, operative details, complications, medical comorbidities, and patient outcomes were retrospectively gathered and analyzed. A total of two patients were isolated after chart review. Both patients were found to have tolerated the procedure well and had no intraoperative complications. In addition, all patients had clinically viable flaps and were satisfied with their surgical results. The free fibular flap may be used effectively in the management of metatarsal defects that have failed prior therapy. In our study, both patients who underwent surgical management with a free fibular flap were noted to have successful long-term results. With the right expertise and patient population, a free fibular flap can be highly successful in the repair of metatarsal defects.

Three-Dimensional Printed Polycaprolactone Mesh in Pediatric Cranial Vault Remodeling Surgery.

The surgical management of craniosynostosis has greatly evolved with improvements in both technology and understanding of the disease process. Some drawbacks remain regarding bone regeneration within the surgical bony gaps. Generally, bony gaps improve in the 12 to 24 months after surgery, but some gaps may remain for longer and cause deformity and/or require additional bony reconstruction. These considerations make tissue-engineered bone very attractive. Novel 3-dimensional printed bioresorbable mesh implants made of Polycaprolactone (PCL) can be used to fill the surgical bony defects. The authors seek to investigate how the use of a 3-dimensional printed biodegradable PCL mesh applied to bony defects in cranial vault surgery affects bone healing. Case series analysis of 8 pediatric patients who have undergone surgical intervention using PCL mesh implants for reconstruction of bony defects during craniosynostosis correction surgery. Radiological evaluation of 3 patients at random time points between 9 and 12 months postoperative revealed persistent bony gaps in areas where PCL mesh was laid. One patient who underwent a subsequent cranial vault surgery at 9 months was found to have less bone regeneration in the defect area where PCL mesh was used when compared with an adjacent area where a particulate bone graft was used. Based on our experience, the use of PCL mesh on its own did not augment bone regeneration. It is possible that a greater amount of time or increased vascularization of the scaffold is required, which supports the concept of regenerative matching axial vascularization or the further addition of osteogenic factors to increase the rate of bone formation.

Custom-Made 3D-Printed Implants as Novel Approach to Reconstructive Surgery after Oncologic Resection in Pediatric Patients.

Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14–44). Three patients died after a mean of 19.3 months postoperatively—two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted.

Reconstruction of Bony Defects after Tumor Resection with 3D-Printed Anatomically Conforming Pelvic Prostheses through a Novel Treatment Strategy.

There has been an increasing interest and enormous applications in three-dimensional (3D) printing technology and its prosthesis, driving many orthopaedic surgeons to solve the difficult problem of bony defects and explore new ways in surgery approach. However, the most urgent problem is without an effective prosthesis and standard treatment strategy. In order to resolve these problems, this study was performed to explore the use of a 3D-printed anatomically conforming pelvic prosthesis for bony defect reconstruction following tumor resection and to describe a detailed treatment flowchart and the selection of a surgical approach. Six patients aged 48-69 years who had undergone pelvic tumor resection underwent reconstruction using 3D-printed anatomically conforming pelvic prostheses according to individualized bony defects between March 2016 and June 2018. According to the Enneking and Dunham classification, two patients with region I+II tumor involvement underwent reconstruction using the pubic tubercle-anterior superior iliac spine approach and the lateral auxiliary approach and one patient with region II+III and three patients with region I+II+III tumor involvement underwent reconstruction using the pubic tubercle-posterior superior iliac spine approach. The diagnoses were chondrosarcoma and massive osteolysis. After a mean follow-up duration of 30.33 ± 9.89 months (range, 18-42), all patients were alive, without evidence of local recurrence or distant metastases. The average blood loss and blood transfusion volumes during surgery were 2500.00 ± 1461.51 ml (range, 1200-5000) and 2220.00 ± 1277.62 ml (range, 800-4080), respectively. During follow-up, the mean visual analogue scale (VAS) score decreased, and the mean Harris hip score increased. There were no signs of hip dislocation, prosthetic loosening, delayed wound healing, or periprosthetic infection. This preliminary study suggests the clinical effectiveness of 3D-printed anatomically conforming pelvic prostheses to reconstruct bony defects and provide anatomical support for pelvic organs. A new surgical approach that can be used to expose and facilitate the installation of 3D-printed prostheses and a new treatment strategy are presented. Further studies with a longer follow-up duration and larger sample size are needed to confirm these encouraging results.

Open complex distal femur intraarticular fracture with Hoffa extension, extensor mechanism tear and post-recovery secondary traumatic peri implant fracture: report on an uncommon chronology

<p class="abstract">Complex distal femur fractures with Hoffa’s extension are uncommon. An associated open fracture with extensor mechanism disruption are rarely reported. A secondary post-traumatic post-recovery peri-implant fracture is a rare presentation. 28-year-old pilon rider male sustained open complex fracture of left metaphyseal distal femur with Hoffa extension and tear in extensor mechanism. He was treated within a golden hour period of wound management. Primary stabilization by distal femoral locking plate and cannulated cancellous screw was done along with primary bone grafting and repair of extensor mechanism. At sixteen weeks, clinic-radiological progression allowed him his pre-injury activities. At seven months, a second trauma resulted in a non-prosthetic peri-implant femoral fracture, another unusual occurrence. Re-osteosynthesis with grafting was done. At twenty months of the primary injury, there was good functional outcome with a painless range of knee flexion to 130° without any extensor lag. Open complex distal femur injury with an associated secondary hit peri-implant fracture presented with significant challenges in management of soft-tissue and reconstruction of bony defect. The early presentation within a golden hour period allowed an early injury assessment to implement primary biological fixation as a treatment modification. Aim was to achieve favorable functional outcome which allowed early return to pre-injury status.</p>

Craniofacial Trauma Due to Stone-pelting - Patterns of Injury and Management.

The aims of the study were to elucidate the pattern of stone-pelting induced cranio-facial injuries and to document soft and hard tissue injuries, their management, and complications. A retrospective descriptive study was conducted using a sample of patients reporting to our department in the years 2015 to 2020. Cranio-facial injuries were assessed for soft and hard tissue injuries, including tissue loss, and corresponding management. Follow up ranged from 18 ± 6 months. & A standardized surgical regime was followed for patient management, which included primary survey, debridement of wounds, and routine primary repair of soft tissue. Bony defect reconstruction was performed by open reduction and internal fixation. Cranial bone was used as split calvarial graft in postcraniectomy cranioplasty procedures, which were performed after 6 months. Local flaps were used for the reconstruction of soft tissue defects. Being a military hospital, majority of cases fell in the 20 to 30 age group with a male preponderance. The etiology in all cases was stone-pelting. Among cranio-facial injuries, cranial vault injuries and mid-face injuries (71%) were most prevalent, mandibular fractures (24%) and remaining were soft tissue injuries (5%). & Frontal & parietal bone injuries were seen in 23.6% cases (n = 9) and orbito-zygomatic complex injuries were seen in (36.8%) cases (n = 14). Isolated blow-out fractures were seen in 4 patients of our series. 52.6% of patients of our series suffered associated soft tissue injuries to the head, face, and neck region. The most common cause of injury was due to the direct impact of stone hitting the mid-face/cranial vault and the most common pattern of injury was gross comminution of the skeleton. & 2 patients suffered ocular injuries that required management and 6 patients of our series who suffered head injuries to the cranium required a secondary cranioplasty procedure (n = 4) &The most commonly used technique for treatment was open reduction internal fixation, which was used in 89% of patients. Soft-tissue injuries overall occurred most frequently on the forehead, nose, lips, and chin which was managed by primary suturing. Cranial vault injuries & orbito-zygomatic complex fractures are most commonly seen in patients with stone-pelting injuries. Early management of such injuries improves outcomes in terms of function and restitution of preinjury skeleton structure. The most common patterns seen is gross comminution to the cranio-facial skeleton that can be treated with immediate primary wound repair after meticulous wound debridement and open reduction and internal fixation. Importance of stone-pelting as a cause of craniofacial injuries is highlighted as it leads to significant disruption of craniofacial skeleton.

Revisionsendoprothetik des Kniegelenks

In addition to periprosthetic infections (PJI), the reconstruction of bony defects is the major challenge of revision total knee arthroplasty (TKA). Infection should be ruled out in all cases prior to operation. Revision TKA requires intensive planning with regard to the needed augmentation possibilities and the stems to be used. The sole biological reconstruction of major defects (AORI II and III) shows high failure rates. Large defects must be augmented by metal (wedges/sleeves/cones). The concept of zonal anchorage (3-zone model) with a stable anchorage in 2 out of 3 zones as close to the joint as possible is currently the standard. According to the model, metaphysis (zone 2) is an increasingly important factor for long-term stable anchoring. The use of cones or sleeves seems to significantly improve the results of revision TKA. The anchorage in zone 3 via stems is still mandatory. Cemented metaphysary anchoring and cement-free diaphysary anchoring stems are available, whereby no clear recommendation for a principle can be given.

Advances on Bone Substitutes through 3D Bioprinting.

Reconstruction of bony defects is challenging when conventional grafting methods are used because of their intrinsic limitations (biological cost and/or biological properties). Bone regeneration techniques are rapidly evolving since the introduction of three-dimensional (3D) bioprinting. Bone tissue engineering is a branch of regenerative medicine that aims to find new solutions to treat bone defects, which can be repaired by 3D printed living tissues. Its aim is to overcome the limitations of conventional treatment options by improving osteoinduction and osteoconduction. Several techniques of bone bioprinting have been developed: inkjet, extrusion, and light-based 3D printers are nowadays available. Bioinks, i.e., the printing materials, also presented an evolution over the years. It seems that these new technologies might be extremely promising for bone regeneration. The purpose of the present review is to give a comprehensive summary of the past, the present, and future developments of bone bioprinting and bioinks, focusing the attention on crucial aspects of bone bioprinting such as selecting cell sources and attaining a viable vascularization within the newly printed bone. The main bioprinters currently available on the market and their characteristics have been taken into consideration, as well.

Osteogenic effects of bioabsorbable magnesium implant in rat mandibles and in vitro

Bone augmentation or grafting is often required for placement of dental implants or surgical reconstruction of bony defects. Bioabsorbable magnesium implant was shown to promote osteogenesis in long bones. The objectives of this study were to determine osteogenic effects of pure magnesium (Mg) in rat mandible and underlying mechanisms. Pure Mg was implanted in sockets after rat mandibular incisors were extracted. Titanium (Ti) was used as control. Systemic effects were determined by serum Mg level and histologic analyses of liver and kidney. Local Mg concentration was measured by microscopy-energy-dispersive spectroscopy (SEM-EDS). Alveolar bone was analyzed by micro-computed tomography (micro-CT) and histology. Osteogenic effects of 0.8 to 20mM magnesium chloride (MgCl2 ) on periosteum-derived cells (PDCs) were evaluated by proliferation, alizarin red staining and quantitative RT-PCR assays. Systemic effects were similar in Mg and Ti groups. Higher local Mg concentration was detected in Mg group (P<0.05). Micro-CT showed higher alveolar bone volume (2- and 6-weeks post-operation) and denser cancellous bone (2weeks post-operation) in Mg group, with significant amount of new subperiosteal bone formation on lateral alveolar bone surfaces by H&E staining. In PDC culture, proliferation rates, osteogenic gene expression for runt related transcription factor 2 (Runx2), bone sialoprotein (Bsp) and osteocalcin (Ocn), as well as calcium nodule formation rose significantly in 5, 10, and 20mM MgCl2 groups. Rapid osteogenesis (especially subperiosteal) is induced by pure Mg in rat mandibular alveolar bone. Osteogenic capacity of PDCs is enhanced by higher Mg ion concentrations in vitro.

Implementation of the three-dimensional printing technology in treatment of bone tumours: a case series

With the ability to overcome specific anatomical and pathological challenges, 3D printing technology is setting itself as an important tool in patient-specific orthopaedics, delivering anatomical models, patient-specific instruments, and custom-made implants. One of the most demanding procedures in limb salvage surgery is the reconstruction of bony defects after tumour resection. Even though still limited in clinical practice, early results of the use of 3D technology are gradually revealing its potentially huge impact in bone tumour surgery. Here, we present a case series illustrating our experience with the use of 3D printing technology in the reconstruction of bone defects after tumour resection, and its impact on cosmesis and quality of life. We performed a retrospective analysis of 11 patients in whom a custom-made 3D-printed prosthesis was used to reconstruct a bone defect after resection for a bone tumour. Ten out of 11 patients were children (aged between 5 and 16 years) with osteosarcoma or Ewing sarcoma of the pelvis (2 children) or the arm (8 children), and one patient was a 67-year-old lady with a chondrosarcoma of the pelvis. All underwent wide resections resulting in considerable bone defects necessitating further reconstruction. Custom-made implants were extremely useful both in reconstruction of bone defects and in terms of cosmesis, recovery facilitation, and quality of life. In this respect, pelvic and humeral reconstructions with 3D-printed custom implants particularly showed a great potential. The mean follow-up was 33 months. Four patients died of disease (36%) and overall the major and minor complication rate was 54% (6 out of 11 patients). Three patients had implant dislocation (27% [3/11 cases]), one had leg-compartment syndrome, and one patient reported limited range of motion. Only two out of 11 patients developed local recurrence. Use of 3D customized implant helped us achieve two major goals in orthopaedic oncology-clear surgical resection and functional recovery with a good quality of life. Large studies with long-term follow-up are needed to reveal the value and future of 3D printing in orthopaedic oncology.

3D Planning and Printing of Patient Specific Implants for Reconstruction of Bony Defects

3D Planning and Printing of Patient Specific Implants for Reconstruction of Bony Defects

3D Planning and Printing of Patient Specific Implants for Reconstruction of Bony Defects.

We are in the midst of the 3D era in most aspects of life, and especially in medicine. The surgical discipline is one of the major players in the medical field using the constantly developing 3D planning and printing capabilities. Computer-assisted design (CAD) and computer assisted manufacturing (CAM) are used to describe the 3D planning and manufacturing of the product. The planning and manufacturing of 3D surgical guides and reconstruction implants is performed almost exclusively by engineers. As technology advances and software interfaces become more user-friendly, it raises a question regarding the possibility of transferring the planning and manufacturing to the clinician. The reasons for such a shift are clear: the surgeon has the idea of what he wants to design, and he also knows what is feasible and could be used in the operating room. It allows him to be prepared for any scenario/unexpected results during the operation and allows the surgeon to be creative and express his new ideas using the CAD software. The purpose of this method is to provide clinicians with the ability to create their own surgical guides and reconstruction implants. In this manuscript, a detailed protocol will provide a simple method for segmentation using segmentation software and implant planning using a 3D design software. Following the segmentation and stl file production using segmentation software, the clinician could create a simple patient specific reconstruction plate or a more complex plate with a cradle for bone graft positioning. Surgical guides can be created for accurate resection, hole preparation for proper reconstruction plate positioning or for bone graft harvesting and re-contouring. A case of lower jaw reconstruction following plate fracture and nonunion healing of a trauma sustained injury is detailed.

Aclinical radiological score for femoral head grafts : Establishment of the Tabea FK score to ensure the quality of human femoral head grafts

EinleitungDie Transplantation humaner Femurköpfe (FK) ist ein etabliertes Verfahren in der knöchernen Defektrekonstruktion bei orthopädischen und unfallchirurgischen Eingriffen, wobei eine standardisierte morphologische Qualitätsbewertung des Femurkopfgewebes bisher kaum erfolgt.Material und MethodenBei 105 Patienten wurde der jeweilige FK im Rahmen einer Hüft-TEP standardisiert entnommen. Anhand klinischer und radiologischer Kriterien (Vorhandensein von Zysten, Nekrosen, Verkalkungen, Deformitäten und Osteoporose) wurde der FK mittels des Tabea-FK-Scores in drei Kategorien (beste/mittlere/schlechte Qualität) eingeteilt. Hiernach erfolgte eine zweite, makroskopische Einteilung der Qualität des in drei Schichten aufgesägten FK. Dieser „Makro-Score“ diente als Goldstandard. Ergänzend wurden eine periphere quantitative Computertomographie (pQCT) sowie histologische Untersuchungen durchgeführt. Die Übereinstimmung des Tabea-FK-Scores sowie der Ergebnisse der ergänzenden Untersuchungen mit dem Makro-Score wurde mittels Sensitivitäten und Spezifitäten beurteilt.ErgebnisseBei 91/105 Patienten (Alter: 68,4 ± 9,9 Jahre, n = 60 Frauen, n = 31 Männer) wurden die explantierten FK in die Studie eingeschlossen. Die Übereinstimmung zwischen dem primären Tabea-FK-Score und dem Makro-Score in Bezug auf die Unterscheidung mittlere/beste sowie schlechte/mittlere Qualität ist als gut einzustufen (Sensitivität 77 % sowie 81 % und Spezifität 76 % sowie 84 %). Die Übereinstimmung des histologischen Befundes mit dem Makro-Score war insgesamt etwas schlechter und wies in Bezug auf die Unterscheidung mittlere/beste sowie schlechte/mittlere Qualität eine Sensitivität von 85 % sowie 54 % und eine Spezifität von 66 % sowie 97 % auf. Der pQCT-Score wies lediglich bei der Unterscheidung mittlere/beste Qualität eine zufriedenstellende Sensitivität (82 %) auf, während diese bei der Unterscheidung schlechte/mittlere Qualität sowie schlechte/mittlere + beste Qualität <10 % betrug.DiskussionDie gute Übereinstimmung zwischen primärem Tabea-FK-Score und makroskopischer Zweitbewertung unterstreicht die Fähigkeiten langjährig operativ tätiger Orthopäden, die Qualität der Knochenspongiosa bereits anhand des Röntgenbildes und des intraoperativen Befundes korrekt einzustufen. Insofern kann die Einführung des Tabea-FK-Scores in die Routineabläufe von Knochenbanken als Qualitätssicherungsmaßnahme empfohlen werden.

THE EFFECT OF PLATELET RICH-FIBRIN WITH AND WITHOUT AUTOGENOUS BONE GRAFT ON BONE REGENERATION FOLLOWING ENUCLEATION OF MAXILLARY CYSTS

Introduction: Reconstruction of bony defects represents a challenging problem for the surgical community. Autologous bone grafting involves utilizing bone obtained from the same individual receiving the graft. Bone can be harvested from the mandibular symphysis (chin area). Autologous platelet rich-fibrin (PRF) is considered to be a healing biomaterial, which has been widely used for accelerating soft and hard tissue regeneration. The use of bone graft in combination with platelet rich-fibrin helps in rapid bone regeneration when compared to natural healing. Objectives: is to compare the effect of platelet rich-fibrin with and without autogenous bone graft on bone regeneration following enucleation of maxillary cysts. Materials and methods: Twenty-one patients with maxillary cysts had been treated with autogenous bone graft with platelet-rich fibrin versus platelet rich-fibrin without autogenous bone graft following cyst enucleation, and the follow up was done for 6 months using Cone Beam Computerized Tomography (CBCT) to evaluate bone regeneration in the defect site. Results:All groups showed increasing in bone density. Group A showed the best results with a mean 330.71, while Group B showed results with a mean 184. Group C showed results with a mean 117.71. Conclusions: PRF can be considered a healing biomaterial, as it features all the necessary parameters permitting bone regeneration without any adverse reaction. The addition of autogenous bone graft to PRF accelerates the regenerative capacity of bone. They give a predictable clinical and radiographic evidence of bone formation and faster healing than using PRF alone.